| National Provider Identifier [NPI]: | 1164412649 |
| Last Name Of The Provider | BOURNE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 CURVE CREST BLVD W |
| Street Address 2 Of The Provider | |
| City Of The Provider | STILLWATER |
| Zip Code Of The Provider | 550826040 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 1105 |
| Number Of Medicare Beneficiaries | 345 |
| Total Submitted Charge Amount | 223824.34 |
| Total Medicare Allowed Amount | 79860.03 |
| Total Medicare Payment Amount | 56802.07 |
| Total Medicare Standardized Payment Amount | 58850.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 173 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 692 |
| Total Drug Medicare AllowedAmount | 308.28 |
| Total Drug Medicare PaymentAmount | 223.21 |
| Total Drug Medicare Standardized Payment Amount | 223.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 932 |
| Number Of Medicare Beneficiaries With Medical Services | 345 |
| Total Medical Submitted Charge Amount | 223132.34 |
| Total Medical Medicare Allowed Amount | 79551.75 |
| Total Medical Medicare Payment Amount | 56578.86 |
| Total Medical Medicare Standardized Payment Amount | 58627.73 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 64 |
| Number Of Beneficiaries Age 65 to 74 | 112 |
| Number Of Beneficiaries Age 75 to 84 | 106 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 204 |
| Number Of Male Beneficiaries | 141 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 296 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 47 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1482 |